Employed vs Self-employed Physicians: Who's Happier? These Are the Tradeoffs

Leigh Page

Disclosures

June 14, 2016

In This Article

Most Employed Physicians Have a Good Relationship With Their Employer

Despite some nagging concerns, most employed physicians (63%) have good relations with leadership at their organizations.

Employers have become more serious about this issue just in the past year, Marc Mertz says. "Several of them are telling us they want to increase 'physician joy' in practice," he says.

Physicians are unhappy when they don't feel they've been heard, he says. To cement the relationship, "employers have been recruiting physicians into leadership roles to provide better support to employed physicians," he says. "Physician-leaders are seeking to reduce administrative burdens, develop more supportive staffing models, and work to improve the efficiency in physicians' offices."

More physicians say employers are making efforts to get their feedback. There was a 5-percentage point rise in this category, to 44% in 2016.

"Hospitals are trying harder to work with physicians," Greg Mertz says. "Healthcare organizations realize that they can't say, 'Take the paycheck and shut up.' For the organization to function well, it needs to have physicians deeply involved in the redesign of the care process and the reduction in care costs."

Perception of autonomy among employed physicians has also improved. More employed physicians (59%) are satisfied with their degree of autonomy, compared with 49% who said so in 2014.

Greg Mertz thinks employed physicians, many of whom are new to the relationship, may be coming to terms with their new status. "Complete autonomy is a dinosaur," he says. "When physicians sign up to be employees, they give up their autonomy." Employed physicians may be more willing to accept their role because in many places, they take a more active role in drawing up the rules for the relationship, he says.

Hospitals have been slowly standardizing the way in which care is delivered. "It used to be that each physician would write orders for a procedure, and staff would carry them out," Greg Mertz says. "Now there are rules for how procedures are carried out. Physicians must answer to treatment protocols, controls on where patients can be sent, and requirements to sign off on patient records."

What Doctors Like Most About Employment

Doctors' favorite aspect of employment is what it isn't—namely, having to run a practice. This was cited by more than one half (54%) of respondents as what they liked best about employment, whereas somewhat fewer (45%) cited not having to deal with insurers or billings. These two categories outpolled all other possible categories—including guaranteed income (42%), a good benefits package (28%), and more regular hours (23%).

"Doctors are happy to turn many of the functions of running a practice over to an organization," Marc Mertz says. "These include billing, IT investment, and—perhaps most of all—the hiring, firing, and disciplining of staff."

Still, "employed physicians do like the regular hours," Marc Mertz says. He notes that hospitalists seem to be the happiest with work/life balance. They are shift-based and take no call.

Even though they enjoy regular hours, Greg Mertz says employed physicians still have to work hard to meet the productivity goals to which their salaries are often tied. "An employed physician often doesn't have the option of working less, like you do in private practice," he says.

Most physicians who switched to employment said their work/life balance improved. Just over one half (54%) saw an improvement, and less than one quarter said it has gotten worse. Those figures are a little disappointing, considering that work/life balance is considered a major draw for seeking employment.

Greg Mertz thinks it may be a matter of unreasonable expectations. "Employed physicians have a lot of advantages in work/life balance, such as a regular schedule, paid vacations, benefits, and less frequent call duties. But unlike their independent counterparts, they can't take time off whenever they like," he says.

Marc Mertz says employed physicians can have long workdays, working into the evening sometimes to complete documentation and other administrative tasks.

Employed physicians don't have a lot of call. Roughly one third (35%) have no night call and/or no weekend call. And of those who do have night call, more than one half (54%) have it once every five to 10 nights, or even more infrequently.

The reason why many employed physicians don't have to take call is that healthcare organizations have hired physicians in a variety of specialties who specifically do this work, Greg Mertz says. "Even when employed physicians still have to take call, it occurs less frequently because they're part of larger pools of doctors sharing call," he says.

"Not having to take call or having less call is often one of the key attractions of employment," Marc Mertz says. Healthcare organizations can justify the cost of paying someone else to do the work, he adds.

Financial security was the most cited reason for employment, but it was cited by just over one third (36%) of employed physicians.

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